HOSTILE WORK ENVIRONMENT COMPLAINT

EEOC Administrative Charge Template

HOSTILE WORK ENVIRONMENT LEGAL STANDARD

Definition

A hostile work environment exists when the workplace is "permeated with discriminatory intimidation, ridicule, and insult that is sufficiently severe or pervasive to alter the conditions of the victim's employment and create an abusive working environment." (Harris v. Forklift Systems, 510 U.S. 17 (1993))

Required Elements

1. Protected Class: You are a member of a protected class
2. Unwelcome Conduct: You were subjected to unwelcome harassment
3. Based on Protected Characteristic: The harassment was based on your protected characteristic
4. Severe or Pervasive: The harassment was sufficiently severe or pervasive
5. Employer Liability: The employer is liable for the harassment

Severe or Pervasive Standard

Courts consider the totality of circumstances:
- Frequency of the conduct
- Severity of the conduct
- Whether it was physically threatening or humiliating
- Whether it unreasonably interfered with work performance
- Effect on the employee's psychological well-being

Note: Petty slights, minor annoyances, and isolated incidents (unless extremely serious) typically do not rise to the level of illegality.

SECTION 1: CHARGE INFORMATION

Charge Presented To:
☐ EEOC (Equal Employment Opportunity Commission)
☐ State/Local FEPA: _____________________________________________________

EEOC Office Location: _________________________________________________

Date of Filing: ________________________________________________________

SECTION 2: COMPLAINANT INFORMATION

Full Legal Name: _____________________________________________________

Street Address: _______________________________________________________

City: _________________________ State: _________ Zip Code: __________

Home Phone: _________________________ Cell Phone: ___________________

Email Address: ________________________________________________________

SECTION 3: EMPLOYER INFORMATION

Company Legal Name: _________________________________________________

Street Address: _______________________________________________________

City: _________________________ State: _________ Zip Code: __________

Phone Number: _______________________________________________________

Number of Employees: _________________________________________________

☐ 15 or more (Title VII, ADA, GINA)
☐ 20 or more (ADEA)

SECTION 4: EMPLOYMENT INFORMATION

Job Title: ____________________________________________________________

Department: __________________________________________________________

Date of Hire: _________________________________________________________

Work Location: ________________________________________________________

Current Status:
☐ Currently Employed
☐ Terminated - Date: _____________________________________________________
☐ Resigned - Date: _______________________________________________________

SECTION 5: BASIS OF HOSTILE WORK ENVIRONMENT

The harassment was based on my:

☐ Race - My race is: ___________________________________________________

☐ Color - Description: __________________________________________________

☐ National Origin - My national origin is: __________________________________

☐ Religion - My religion is: ______________________________________________

☐ Sex (including pregnancy, sexual orientation, gender identity)
☐ Sexual harassment
☐ Gender-based harassment
☐ Pregnancy-based harassment
☐ Sexual orientation-based harassment
☐ Gender identity-based harassment

☐ Age (40 or older) - My age is: _________________________________________

☐ Disability - My disability is: ___________________________________________

☐ Genetic Information

☐ Multiple protected characteristics (explain): _______________________________

SECTION 6: THE HARASSER(S)

A. Primary Harasser

Name: ________________________________________________________________

Job Title: _____________________________________________________________

Department: __________________________________________________________

Relationship to You:
☐ Direct supervisor
☐ Manager (not direct supervisor)
☐ Coworker
☐ Subordinate
☐ Client/Customer
☐ Vendor/Contractor
☐ Other: ________________________________________________________________

B. Additional Harassers (if applicable)

SECTION 7: DESCRIPTION OF HARASSING CONDUCT

A. Types of Harassment Experienced

Check all that apply:

Verbal Harassment

☐ Offensive jokes related to protected characteristic
☐ Slurs, epithets, or name-calling
☐ Derogatory comments about protected group
☐ Stereotyping comments
☐ Threats or intimidation
☐ Unwelcome comments about appearance
☐ Questions about personal life related to protected characteristic
☐ Spreading rumors based on protected characteristic
☐ Other verbal conduct: ___________________________________________________

Physical Harassment

☐ Unwanted physical contact or touching
☐ Assault or physical threats
☐ Blocking movement or cornering
☐ Gestures or leering
☐ Following or stalking behavior
☐ Other physical conduct: _________________________________________________

Visual/Environmental Harassment

☐ Offensive images, pictures, or cartoons
☐ Offensive emails, texts, or messages
☐ Offensive screensavers or desktop images
☐ Graffiti related to protected characteristic
☐ Display of offensive objects or symbols
☐ Other visual conduct: ___________________________________________________

Work-Related Harassment

☐ Sabotage of work
☐ Exclusion from meetings or work activities
☐ Unfair work assignments
☐ Excessive criticism or scrutiny
☐ Setting up for failure
☐ Withholding information needed to do job
☐ Other work-related conduct: _____________________________________________

B. Specific Incidents

Document specific incidents in detail. Include dates, locations, what was said or done, who was present, and any witnesses.

INCIDENT 1:

Date: ________________________________________________________________

Time: ________________________________________________________________

Location: _____________________________________________________________

Harasser(s) Involved: ___________________________________________________

Witnesses Present: _____________________________________________________

What Happened:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Exact Statements Made (if verbal harassment):

___________________________________________________________________________

___________________________________________________________________________

How Did This Make You Feel?

___________________________________________________________________________

INCIDENT 2:

Date: ________________________________________________________________

Time: ________________________________________________________________

Location: _____________________________________________________________

Harasser(s) Involved: ___________________________________________________

Witnesses Present: _____________________________________________________

What Happened:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Exact Statements Made (if verbal harassment):

___________________________________________________________________________

___________________________________________________________________________

How Did This Make You Feel?

___________________________________________________________________________

INCIDENT 3:

Date: ________________________________________________________________

Time: ________________________________________________________________

Location: _____________________________________________________________

Harasser(s) Involved: ___________________________________________________

Witnesses Present: _____________________________________________________

What Happened:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Exact Statements Made (if verbal harassment):

___________________________________________________________________________

___________________________________________________________________________

How Did This Make You Feel?

___________________________________________________________________________

(Attach additional pages for more incidents)

SECTION 8: TIMELINE AND FREQUENCY

A. Duration of Harassment

Date Harassment First Occurred: _________________________________________

Date of Most Recent Incident: ____________________________________________

Total Duration: ________________________________________________________

Is the Harassment Ongoing? ☐ Yes ☐ No

B. Frequency

How often did harassing incidents occur?

☐ Daily
☐ Multiple times per week
☐ Weekly
☐ Multiple times per month
☐ Monthly
☐ Occasional/Sporadic
☐ One severe incident

Approximate Total Number of Incidents: ___________________________________

SECTION 9: SEVERE OR PERVASIVE ANALYSIS

A. Severity Factors

Was the conduct physically threatening? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

Was the conduct humiliating? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

Did any single incident involve extreme conduct? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

B. Pervasiveness Factors

How frequent was the harassment?
☐ Constant/Daily
☐ Frequent (multiple times weekly)
☐ Regular (weekly)
☐ Occasional (monthly or less)

How long did the harassment continue? ___________________________________

Was the workplace atmosphere generally hostile? ☐ Yes ☐ No

C. Impact on Work

Did the harassment interfere with your work performance? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

___________________________________________________________________________

Did you dread coming to work? ☐ Yes ☐ No

Did you consider quitting because of the harassment? ☐ Yes ☐ No

D. Psychological Impact

Did the harassment affect your mental/emotional well-being? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

___________________________________________________________________________

Did you seek medical or mental health treatment? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

SECTION 10: REPORTING AND EMPLOYER RESPONSE

A. Internal Complaints

Did you report the harassment to anyone at your employer? ☐ Yes ☐ No

If yes, complete the following for each report:

Report 1:

Date: ___________________________________________________________________

To Whom (Name and Title): ________________________________________________

How (verbal, written, HR hotline): ___________________________________________

What Did You Report: _____________________________________________________

___________________________________________________________________________

Response: ________________________________________________________________

___________________________________________________________________________

Report 2:

Date: ___________________________________________________________________

To Whom (Name and Title): ________________________________________________

How (verbal, written, HR hotline): ___________________________________________

What Did You Report: _____________________________________________________

___________________________________________________________________________

Response: ________________________________________________________________

___________________________________________________________________________

B. Employer's Response

Did the employer take any corrective action? ☐ Yes ☐ No

If yes, what action was taken?

☐ Investigation conducted
☐ Harasser warned
☐ Harasser disciplined
☐ Harasser transferred
☐ Harasser terminated
☐ Training provided
☐ Policy review
☐ Other: ________________________________________________________________

Was the corrective action effective? ☐ Yes ☐ No

Did the harassment stop after you reported it? ☐ Yes ☐ No

Did you face any retaliation for reporting? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

C. Employer's Anti-Harassment Policy

Does the employer have an anti-harassment policy? ☐ Yes ☐ No ☐ Unknown

Were you aware of the policy? ☐ Yes ☐ No

Did you follow the complaint procedure? ☐ Yes ☐ No

If no, why not?

☐ Was not aware of procedure
☐ Feared retaliation
☐ Believed it would be futile
☐ Harasser was the person to report to
☐ Other: ________________________________________________________________

SECTION 11: EMPLOYER LIABILITY

A. Supervisor Harassment

If the harasser was your supervisor, the employer may be automatically liable or have an affirmative defense.

Was the harasser your supervisor? ☐ Yes ☐ No

If yes:
Did the harassment result in a tangible employment action (termination, demotion, etc.)? ☐ Yes ☐ No

If no tangible employment action:
Did the employer have a reasonable anti-harassment policy? ☐ Yes ☐ No ☐ Unknown

Did you unreasonably fail to use the complaint procedure? ☐ Yes ☐ No

B. Coworker Harassment

If the harasser was a coworker, the employer is liable if it knew or should have known and failed to take prompt corrective action.

Was the harasser a coworker? ☐ Yes ☐ No

If yes:
Did the employer know about the harassment? ☐ Yes ☐ No

If so, how?
☐ I reported it
☐ Someone else reported it
☐ Management witnessed it
☐ It was open and obvious
☐ Other: ________________________________________________________________

Did the employer take prompt and effective action? ☐ Yes ☐ No

SECTION 12: STATE-SPECIFIC NOTES

California

• State Law: California FEHA, Government Code § 12940(j)
• Broader Standard: California uses "totality of circumstances" and does not require conduct to be "severe and pervasive" to the same degree
• Employer Liability: Employers strictly liable for supervisor harassment
• Filing Deadline: 3 years to file with CRD
• Training Requirement: Employers with 5+ employees must provide harassment prevention training

Texas

• State Law: Texas Labor Code Chapter 21
• Standard: Generally follows federal "severe or pervasive" standard
• Filing Deadline: 180 days to file with TWC-CRD

Florida

• State Law: Florida Civil Rights Act, Florida Statutes § 760.10
• Standard: Generally follows federal standard
• Filing Deadline: 365 days to file with FCHR

New York

• State Law: New York State Human Rights Law, Executive Law § 296
• Broader Standard: As of 2019, harassment need only be "above petty slights" (lower threshold than federal)
• NYC: NYC Human Rights Law provides even broader protection - conduct need not be "severe or pervasive"
• Filing Deadline: 3 years to file with DHR (as of 2/15/2024)
• Model Policy: NY employers must adopt sexual harassment prevention policy

SECTION 13: WITNESSES

SECTION 14: EVIDENCE

Documents/Evidence You Have:

☐ Emails showing harassment
☐ Text messages
☐ Voicemails
☐ Photos of offensive materials
☐ Screenshots
☐ Written complaints you made
☐ HR investigation documents
☐ Contemporaneous notes/journal
☐ Medical/counseling records
☐ Performance evaluations
☐ Witness statements
☐ Other: ________________________________________________________________

SECTION 15: DAMAGES

Economic Damages

Lost wages (if resigned or terminated): $ _________________________________

Medical/Counseling expenses: $ _________________________________________

Other economic losses: $ _______________________________________________

Non-Economic Damages

Describe emotional distress, humiliation, and mental anguish:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

☐ I sought medical or mental health treatment
☐ I experienced anxiety, depression, or other psychological effects
☐ The harassment affected my personal relationships
☐ The harassment affected my physical health

SECTION 16: RELIEF REQUESTED

☐ Back pay (if terminated or resigned)
☐ Front pay
☐ Reinstatement
☐ Compensatory damages for emotional distress
☐ Punitive damages
☐ Attorney's fees and costs
☐ Stop the harassment
☐ Discipline/termination of harasser
☐ Transfer of harasser (not me)
☐ Policy changes
☐ Training for employees
☐ Removal of negative information from my file
☐ Other: ________________________________________________________________

SECTION 17: FILING DEADLINES

Note: For ongoing harassment, each incident may restart the filing period under the continuing violation doctrine.

SECTION 18: VERIFICATION AND SIGNATURE

I declare under penalty of perjury that the information provided in this charge is true and correct to the best of my knowledge, information, and belief.

I understand that:
- Harassment based on protected characteristics that creates a hostile work environment is illegal
- I should document all incidents with as much detail as possible
- I should report harassment to my employer when possible
- Filing this charge protects my right to file a lawsuit if necessary

Signature: ____________________________________________________________

Printed Name: _________________________________________________________

Date: ________________________________________________________________

ATTACHMENT CHECKLIST

☐ Detailed incident log with dates and descriptions
☐ Copies of offensive communications (emails, texts)
☐ Photos of offensive materials
☐ Written complaints made to employer
☐ Employer's responses to complaints
☐ Anti-harassment policy (if available)
☐ Performance evaluations
☐ Medical/counseling records (if seeking damages)
☐ Witness contact information
☐ Additional pages for more incidents

HOSTILE WORK ENVIRONMENT CHECKLIST

Before filing, confirm:

☐ Protected Class: The harassment relates to a protected characteristic (race, color, religion, sex, national origin, age, disability, genetic information)

☐ Unwelcome: The conduct was unwelcome (you did not invite or welcome it)

☐ Severe or Pervasive: The conduct was either:
☐ Severe (extreme, even if isolated), OR
☐ Pervasive (frequent/ongoing)

☐ Objective Standard: A reasonable person would find the environment hostile

☐ Subjective Standard: You actually found the environment hostile

☐ Employer Liability: The employer is liable because:
☐ Supervisor harassment with tangible employment action, OR
☐ Supervisor harassment without tangible action (employer may have defense), OR
☐ Coworker harassment and employer knew or should have known and failed to act

Hostile work environment claims require careful documentation. Keep detailed records of all incidents, report through proper channels when possible, and consult with an employment attorney to evaluate the strength of your claim.